Re: Insulin response time

I was hoping someone might have some input for me.  I take lantus in the morning and at night and I take humalog for food or as needed.  I first take my blood sugar in the morning when I get to work and it is usually around 150 to 250  (Yeah a little high).  I then take my lantus and my humalog right before I have breakfast at the same time.  Most mornings my breakfast is oatmeal with dried cranberries and oatmeal.  My bloodsugar is always jumping after this.  I will take my bloosugar around 9.30 and it can be up in the three hundreds.  If I take more insulin at this point I generally have a pretty bad low.  Any ideas on what I am doing wrong?  Any suggestions?

One other thing is that if I wake up in the middle of the night and have a 250 I can take one unit of humalog to bring it back down which will generally cause a low blood sugar. 

I am really concerned to have my sugars going this high between meals!

I would definitely talk to your endo about all this. As far as being high after breakfast maybe your insulin to carb ratio isn't low enough and you might just need to take a little more humalog in the Am. Are you waiting more than 2 hours after you eat to test? If you are testing less than 2 hours after breakfast you may be reading a false high, as all of the insulin hasnt finished working yet. Are you going high after every meal? Because then you may need to adjust your ratio all day. For the night time highs I would say you may need to adjust your lantus doses and/or the times you are taking it. When I was on humalog and lantus I only took it at night so I am not sure how exactly you would change it with the 2 doses. I hope this is helpful, but I would definitely call or email your doctor and tell them what ur numbers are looking like and when/how much insulin you are taking so they can help you. Good Luck!

sarabago

I was hoping someone might have some input for me.  I take lantus in the morning and at night and I take humalog for food or as needed.  I first take my blood sugar in the morning when I get to work and it is usually around 150 to 250  (Yeah a little high).  I then take my lantus and my humalog right before I have breakfast at the same time.  Most mornings my breakfast is oatmeal with dried cranberries and oatmeal.  My bloodsugar is always jumping after this.  I will take my bloosugar around 9.30 and it can be up in the three hundreds.  If I take more insulin at this point I generally have a pretty bad low.  Any ideas on what I am doing wrong?  Any suggestions?

One other thing is that if I wake up in the middle of the night and have a 250 I can take one unit of humalog to bring it back down which will generally cause a low blood sugar. 

I am really concerned to have my sugars going this high between meals!

I was having high post numbers. I started to inject for food about 45 before I eat and it is helping. Trying to time insulin coming on and food in. My post numbers have been good.

I'm on a split dose of lantus (i.e. 2x/day) and humalog too. What you're describing sounds very typical for me. I tend to run low in the early morning but high after breakfast. Check w/ your endo, but I would: 1) make sure you have enough Lantus overnight so you don't have to correct if possible (obviously, there are always "bad" nights, but in general!), 2) like Keith mentioned, I inject 20-30 min before eating breakfast to make sure the humalog is into my system, but don't have to do this at other meals, 3) use a lower insulin to carb ratio at breakfast (I use 1:5 instead of 1:8 later in the day), and 4) I try to keep my breakfasts as low carb as possible and add in protein to slow the absorption of the carbs. Good luck!

Your endo will be the best person to consult but it sounds llike your lantus rate needs to be raised as well as the humalog to carb ratio in your diet. Also the peak time for humalog is usally between 30 mins to 45 minutes depending on your bodies metabolic rate so take your sugars/ insulin between twenty to thirty minutes before meals as well as check the sugar between two to three hours after the meal and record them so your endo can make the nesscary adjustments. Lantus is does not have a peak time and stays active throughout the entire day. Humalog peak in about thirty minutes and stays active up to two hours in your system before it wears off.  Also dicuss your diet with your endo and dietian as their are various rates at which food type like carbs, proteins and sweet foods are broken done into glucose and begin to run their course through your bloodstream and body.  Foods like candy, orange and really sweet food item are broken down into glucose within 15 mintues and will spike your sugars for the next thirty minutes to an hour. Straches and carbs take 30 to 45 minutes to be processed and will keep you elevated for around two hours. Proteins can be the trickest as they take three hours to be processed and will stay active in your system for up to six hours. That is why nearly every type one has had terrible bloodsugar after eating foods like pizza. It is a nasty combination of heavy protein and straches. Oatmeal is a heavy starch and carband the cranberries are consider a sweet food. You will more then likely notice this pattern. You take your sugar and insulin and then eat and within 30 minutes your bloodsugar is quite elevate where you then try to treat it with additional insulin only to find yourself with a low blood sugar within an hour to hour and 45 minutes. The roller coaster of your digestion being out of sync with your insulin's timing of response to the glucose in your system. You take it it too late prior to eating and you get the high blood sugars, then if you take it to late or more in response to the high you find yourself facing a low as a result of the glucose not being there when the insulin reaches its peak effectiviness.

This is all really good advice. I take Lantus too and I started taking it at night because my mornings were always different. I know Lantus lasts 24 hours and I thought maybe it gets weaker right before it wears off completely. I don't know if it really made a difference, but I know it's easier for me to keep the injection times consistent with a night schedule.

I went out two nights ago--had 3 shots of vodka and one beer, felt pretty good, tested and was at 36--yeesh. 

I also have trouble in the mornings.  I am on a pump and just got a cgm  about 2 days ago.  My morning blood sugars when I get up are great, then as soon as I start going- they go up.  I feel like I have a much slower metabolic rate in the morning and am thinking about 1- talking with my endo about dealing with this and 2- talking with a nutritionist about foods that may be better to eat in the morning.  I seem to have a lot of trouble processing the carbs and rapidly absorbing the insulin in the am.  I was thinking about going more protein in the morning, but wanted to talk with a nurtritionist too.  It really sucks when you are trying to wake up and dealing with a bad blood sugar too!  Anyone use fast acting insulin?  I am wondering if it is time for me to switch types- I am currently on Humalog.

I am on the pump now, but when I was on Lantus, I took it only once a day.  It is supposed to last 24 hours at a pretty flat delivery rate.  I am not a doc, and I don't play one on tv so maybe your treatment plan is different.  I hate those roller coaster rides.  Make me feel like crap when it happens to me.  Like today, I just feel washed out.  Ain't diabetes fun!  (sarcasm).

Remeber that Lantus and Humalog have different acidic or ph values and can interfere with each other.  

Hi,

I don't know if this will help, but here are my 2 cents. My personal experience with oatmeal (which I love) has been that when I eat oatmeal it raises my glucose higher than the same amount of carbs eaten in another form (such as bread) and that it also digests slower than other carbs, which affects the time when my glucose peaks. In fact, to not be high in the middle of the day after an oatmeal breakfast I have to skip lunch (I take regular in the AM, so I have insulin in me until about dinner, at which point I now switched to Humulog as R no longer is available in pen form). I have been a Type I for almost 40 years now and I have learned that all carbs are not the same. Also, you indicate you eat it with dried cranberries - what is the glucose level on those? That may also have an effect as dried fruits tend to be higher in fructose anyway, and if they have sugar on top of that your problem may be both the food you are eating, how your body reacts/digests it, and the mix/dose of insulins.

I don't have anything I can provide you regarding the lantus or Humulog (which I just started and which I am learning how my body reacts to, when to take, and how much to take right now).

You can take your insulin early, but sometimes that's not the most realistic thing to do.  You seem to have a pretty consistent morning routine, so it might work for you.

I started taking Symlin to counter that after-meal spike.  It's a different hormone shot that I take at breakfast and at dinner, when I have a little bit of the same problem, and it's worked really well.  Using my CGM, I can look at a graph and tell pretty instantly if I forgot to take the Symlin because that spike always comes back, but if I treat it, I'm down to 50 or lower by lunch time.  It made my A1C drop a bit, and it also helped me lose weight.  I like it a lot.

I've consistently had this same problem for years....post breakfast spikes in the 300s despite accurate carb counting and changing my basal and bolus rates w/ my endo.  I've heard about Symlin...I'm wondering about the nauseousness that comes from the drug.  Also, I've been on a pump for over a decade and I don't miss shots at all!  In fact, my biggest hesitation about taking Symlin involves returning to shots.  Anyone have any experience being on a pump and taking Symlin?  Does it really help bring down A1C?  what about post meal spikes?

Thanks! 

Hilary

I've consistently had this same problem for years....post breakfast spikes in the 300s despite accurate carb counting and changing my basal and bolus rates w/ my endo.  I've heard about Symlin...I'm wondering about the nauseousness that comes from the drug.  Also, I've been on a pump for over a decade and I don't miss shots at all!  In fact, my biggest hesitation about taking Symlin involves returning to shots.  Anyone have any experience being on a pump and taking Symlin?  Does it really help bring down A1C?  what about post meal spikes?

Thanks! 

i am on the pump and took symlin for about 6 months. for me, it didn't do much of anything. i still took the same amount of insulin, and didn't see a change in my blood sugars. and it was a pain in the ass to have both a bolus and a shot to do at every meal. after i got off the symlin, i decided to just be more aggressive with my blood sugars/timing of insulin and that has helped me a lot more. i haven't had an a1c since november (can't go until july), but i'm confident i'll see improvements. while i was on symlin, my a1c didn't change at all (7.4 both times). it has dropped slightly since then (7.1), and i'm thinking i'll be under 7.0 at my next appointment.

Hilary,

I had the same problem, for years, with those post-meal spikes being really high.  What solved it for me was taking my boluses (I'm on a pump, using Humalog) 10 -15 minutes before I begin eating.  It's a pain, and I can't always guess accurately, but if I'm doing things right, I don't see anything over about 180 in the two hours after my meal.  How long are you waiting between insulin and food?

This may be part of my problem.  I'm not bolusing until 15-20 minutes after I eat...I'm hoping that guesstimating how many carbs I will consume in the meal will help to bring these numbers down.  I've found them particularly frustrating lately and like I'm on a yoyo.